Sleep apnoea (obstructive)

You will find here all the information about the health risks of snoring and obstructive sleep apnoea and how they can be cured by a newly developed surgical method, the so-called rotation advancement (bimaxillary rotation advancement). Heavy snoring indicates life threatening sleep apnoea, as a consequence, symptoms such as tiredness during the daytime, falling asleep while driving, lack of concentration, drop in physical performance due to lack of oxygen in the blood can all occur as a consequence.

What is sleep apnoea?

sleep apnoea is a life threatening diseases that is recognised by loud snoring and stoppage of breathing while the person is sleeping. The patient will not be aware of these characteristics, the partner of a person with sleep apnoea on the other hand suffers much due to the loud snoring; separate bedrooms are often an unmistakable sign of sleep apnoea.

Causes of sleep apnoea

Schematic anatomic representation of the problem of sleep apnoea: Already in the upright position, the respiratory (pharyngeal) airways are narrow, but clear. In the moment the patient undergoes immense physical strain, he does not get enough air or oxygen and feels he cannot perform at sports as others.

In the reclining sleeping position, the narrow respiratory airways are closed entirely by the tongue which sinks backwards, breathing stops, the oxygen levels in the blood drop, the entire organism suffers. The life expectancy of patients with sleep apnoea is known to be shorter.

Anatomically, the tongue is fixed to the lower jaw. However, if the lower jaw is too small and not advanced enough (receding lower jaw),even the tongue lies too far back inside the mouth and blocks the respiratory airways due to lack of space. The patients cannot sleep on their back, since the tongue will slip back and close the respiratory path like a cork.
This recession of the lower jaw can be recognised immediately in the profile (please see figure on the right), because even the chin lies too far back, and often there is a double chin.

Symptoms

Signs of obstructive sleep apnoea:

Loud snoring that wakes up the partner
Tiredness during the daytime
Exhaustion
Dozing off while driving
Lack of concentration
Dropping off to sleep in seconds
Heavy, irregular snoring with more than 10 breathing arrests in an hour
Lack of drive, sluggishness and constant tiredness
Disturbed sleep, increased urination and night-time sweating
Often, patients suffer from being overweight, which further aggravates the snoring. A receding chin and a double chin are further indicators that can be identified easily in the profile view.

Consequences of sleep apnoea and snoring

The life threatening consequences of obstructive sleep apnoea are caused by the lack of oxygen in the blood. The oxygen deficiency can result in the death of brain cells during sleep. Fatigue during the day time, dozing off in front of the television or while driving, lack of concentration, sharp fall in performance are alarm signs that point to a sleep apnoea. The patients, who are frequently overweight, suffer from high blood pressure and are prone to heart attacks and strokes.

Treatment

In the treatment of obstructive sleep apnoea disease, we differentiate between causal and symptomatic treatments.

Before

Typical physiognomy in the case of sleep apnoea and small lower jaw and short distance between chin/neck. The patient underwent orthodontic treatment for eight years with extraction of teeth, he has normal teeth positioning.

Before

The extremely narrow respiratory paths are clearly recognisable.

After

Condition after rotation of the upper jaw/lower jaw complex and simultaneous nose correction.

After

After rotating the upper jaw and lower jaw, the respiratory paths are wider, sleep apnoea has been corrected definitively.

Symptomatic treatment

The symptomatic treatment consists mostly in using a breathing mask that is connected to a machine that builds up additional pressure while breathing, so that enough air passes into the lungs. This gives rise to a certain excess pressure in the lungs, which in turn could trigger other complications. There are CPAP devices which can be carried along while travelling, however, many patients cannot cope with this treatment over long term, with the breathing mask strapped on.
Another treatment lies in the use of protrusion bars, i.e., synthetic devices similar to prostheses which force the receding lower jaw into a prognathal position. This causes often painful damages to the joints of the jaw through the constant luxation position of the head of the lower jaw (mandibular condyle), and the discus in the joint.
Operations for improving the nasal passageway or dangerous measures with the laser on the soft palate and the palate will not cure sleep apnoea.
As an intermediate treatment we recommend and also perform several symptomatic measures.

Causal treatment

The causal treatment of obstructive sleep apnoea consists in the operative advancement of the jaw, so that enough space is created for the tongue and the upper respiratory paths are open. By advancing the upper and lower jaws, the upper respiratory paths get extended, which results in a rapid improvement of the health condition immediately after the operation. The patient will be able to sleep well again, the normal levels of oxygen saturation improve the cardio vascular circulation, and the snoring disappears.
Simultaneously we correct nasal septal deviation and too large turbinates as a routine.
As a pleasant side effect, every repositioning of the upper and lower jaw is accompanied by increased attractiveness and the temporarily restricted food intake after the operation, usually brings about a weight loss of at least five to ten kilograms.

Operation

All interventions are planned accurately to the millimetre with the help of a model and transferred exactly to the patient during the actual operation. Here, the experience of the surgeon plays a decisive role. Further, the patient also gets an opportunity to have a digital photographic plan of his treatment made. In this way, the patient can get an idea of the planned optimisation of his appearance and can learn to cope with it in advance.

To learn more about snoring and sleep apnoea please also visit our web site www.schluss-mit-schnarchen.info.

Before: Patient suffering from snoring and sleep apnoea with receding lower jaw. The nose had been operated four times already elsewhere, in vain, to correct the sleep disturbance.
Before: The teleradiograph shows the extreme constriction of the respiratory airways (please see arrows).
After: After the upper and lower jaw rotation, the respiratory airways have become wide enough and as a positive side effect make the facial proportions look significantly more attractive.
After: The teleradiograph (cephalogram) shows the massive extension of the respiratory airways (please see arrows).
Before: Patient with a severe sleep apnoea before the operation. The profile clearly shows a receding chin that is too small, one of the indicators for sleep apnoea.
After: No more snoring, instead, increased attractiveness and professional success after the operation.
Before: Profile in the case of obstructive sleep apnoea with small lower jaw and chin.
After: As a result of the operation the facial proportions are restored to normal.
Before: Extreme recession of the lower jaw that is too small, with teeth positioned normally because of orthodontic dental treatment, however, strong tilting of the lower front teeth towards the front.
After: Result following rotation advancement (according to Sailer, bimaxillary advancement) and chin correction. The narrow respiratory paths are normally wide, the face is attractive.

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